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Preventing and coping with hair loss
How does chemotherapy affect your hair?
Chemotherapy often causes hair loss otherwise known as Alopecia. This is because the cells in the hair follicles grow fast and chemotherapy damages fast growing cells. (see what is chemotherapy). Hair loss is not permanent and it will grow back once your treatment has ended. Not all drugs cause hair loss - Some just cause thinning and others cause dramatic hair loss including the body hair and eye brows. Furthermore, different people have different tolerances to the drugs. Occasionally, some people loose their hair when it is not expected and sometimes in other cases no hair loss occurs when it is expected. (See table below for a list of chemotherapy drugs likely to cause hair loss)
Hair loss can start any time from after the first few days after chemotherapy to within a few weeks. However, your hair will grow back once treatment is complete although to start with your hair will grow back very fine, very like a babies hair. Your clinic nurse can arrange for you to have a wig before your treatment starts . After three to six months you should have regained a full head of hair although it may be slightly different to before your treatment in terms of colour and texture.
Prevention of hair loss
Not everyone can tolerate wearing the cold cap as it can feel very cold. This discomfort varies from patient to patient so it is not a failure if you can't wear it and it has no influence on the outcome of your treatment. In other clinical trials to date, less than 2% of patients who had retained their hair did not continue with the procedure.
While cold caps may be effective in preventing hair loss for some chemotherapy drugs they are not successful for all drugs. Your doctor or nurse will be able to advise you.
The cold cap system
How it works?
Studies have shown that scalp cooling is effective in preventing hair loss in patients treated with some chemotherapy drugs. Cooling the scalp to a temperature of +17 oC to achieve a subcutaneous temperature of +20 0C (68 oF) constricts the blood supply to hair follicles diminishing or abolishing their perfusion hence preventing high chemotherapy dose delivery during the initial phase of chemotherapy. Further, coldness itself reduces the availability of (chemotherapy) cytotoxic drugs to the cells of the hair follicles by directly reducing their metabolic rate. It is the combined effect of both these mechanisms, induced by cooling the scalp, that prevents or reduces hair loss (alopecia).
The cold cap system works better for some drugs than others. Some clinical trials show a success rate of up to 85% with:-
Docetaxel (taxotere) Epirubicin
Paclitaxel (Taxol) Cyclophosphamide.
Coping with hair loss
The cold cap may not work with all drugs or may not be tolerated. Here are some tips from patients to help you cope with hair loss if it does occur. Hair loss can occur at varying degrees and to different parts of the body depending on the type or combination of drugs used:
* baldness may be temporary, partial or total
* you may lose eyebrows, eyelashes, body and pubic hair
* you may not lose any hair at all
Hair loss can start any time from after the first few days after chemotherapy to within a few weeks. However, your hair will grow back once treatment is complete although to start with your hair will grow back very fine, very like a babies hair. Your clinic nurse can arrange for you to have a wig before your treatment starts . After three to six months you should have regained a full head of hair although it may be slightly different to before your treatment in terms of colour and texture.
Radiotherapy and hair loss
Hair loss can also occur after you have had radiotherapy, again as a result of damaged hair follicles. However, you will only loose hair from the area being treated with radiotherapy. This hair lose is usually temporary and your hair will regrow completely after your treatment. However, the speed and thickness of this regrowth is dependent on the length treatment and the quantity of radiotherapy you received. On average it takes between six and twelve months after you have finished your treatment. If your hair does not regrow or comes back very patchy, wearing a wig is a possibility.
Practical Advice
You can ease the pull of long hair on your scalp by having it cut into a shorter style before you undergo treatment.
* Avoid using harsh chemicals and shampoo on your hair as these can cause the scalp to become dry and itchy. Try switching to gentler products. Do not perm you hair for at least six months after your treatment. If your scalp does become too dry you can gently massage it with a light moisturizer.
* Use a soft hairbrush to prevent irritating your scalp if it is tender.
* Avoid nylon pillowcases as they can irritate the scalp. Use cotton as an alternative.
* Wherever possible, let your hair dry naturally as hairdryers and rollers can further damage brittle hair. Avoid sleeping with hair rollers in place.
* If you have lost underarm hair, try not to use deodorants and use unscented talcum power instead.
Wearing a wig
If your hair does not grow back, is patchy, or you are still undergoing chemotherapy, you might consider wearing a wig. There are several varieties in all styles and colours, and can be made from both synthetic and human hair, or a combination of both.
Paying for a wig
You are entitled to free wig if you are in inpatient when the wig is supplied or if you are on State benefits/allowances.
If you are not eligible to receive a wig free, then you are still able to get one at NHS prescription charge, prices are approximately £55 for an acrylic wig, £140 for half real hair wig and £205 for a full real hair wig, or through the Cancer Relief Macmillan Fund. Your doctor, nurse or social worker should be able to advise you.
Children and young adults up to the age of 19 in full time education are also entitled to free wigs if hair loss is as a result of their treatment. If they are going to have intermittent treatment over a few years they will probably need a new wig every time as their head size grows. Alternatives to wigs are scarves, hats and baseball caps.
If you want to choose a wig from a shop, hairdresser or wig retailer, you are free to do so although it is likely to cost you more. However, because you have lost your hair due to chemotherapy or radiotherapy, you are exempt from paying VAT if you fill in a VAT form. This must be presented at the time when you buy the wig as it cannot be claimed back later.
Wig specialists
A wig specialist will help you choose a colour and style that suits you. You may want the help and advice of your regular hairdresser or a friend, and your wig can be chosen at leisure.
How to wear a wig
There are several different tips to make sure your wig is secure:-
* Although a well fitting wig should stay in place by itself you can also use double-sided tape. Wig specialist’s stock hypo-allergic double-sided tape that will not irritate your skin. The tape is applied to the underside of the wig. Surgical spirit can be used to remove any remaining adhesive.
* The lining of the wig can sometimes irritate the scalp. You may find it helpful to wear a thin cotton scarf or skullcap under your wig. These are usually available from wig suppliers.
* You will need to have your wig adjusted as you lose more hair.
* Ensure that you receive instructions on how to care for your wig and how to have it re-styled.
* Try to avoid using hair spray on you wig as this can make it look unnatural.
Loss of other facial hair
It is possible to loose the eyebrow hair. There is a remarkable make up process called micropigmentation to which can simulate cosmetically perfect eyeliner or eyebrows hair. It is only available privately - more information can be found on www.permanent-makeup.com
Table to summarise risk of hair loss with different chemotherapy drugs:-
| Drugs which usually do cause hair loss | Drugs which sometimes cause hair loss | Drugs which usually don't cause hair loss |
| Adriamycin | Amsacrine | Methotrexate |
| Daunorubicin | Cytarabine | Carmustine(BCNU) |
| Etoposide | Bleomycin | Mitroxantrone |
| Irinotecan (Campto) | Busulphan | Mitomycin C |
| Cyclophosphamide | 5 Fluorouracil | Carboplatin |
| Epirubicin | Melphalan | Cisplatin |
| Docetaxel, (Taxotere) | Vincristine | Procarbazine |
| Paclitaxel, (Taxol) | Vinblastine | 6-Mercaptopurine |
| Ifosphamide | Lomustine(CCNU) | Sreptozotocin |
| Vindesine | Thiotepa | Fludarabine |
| Vinorelbine | Gemcitabine | Raltitrexate (Tomudex) |
| Topotecan | Capecitabine |
UK Wig specialists:-
Banbury – Postiche Ltd , Little
Beesley Hair Centre, 100 high Street Sandhurst
Carpenters Hair Centre,
Face Facts Hair centre. Jews House 1 Steep Hill
Hairdressing & Beauty Association.
Hair Plus. 10
The Alopecia Patients Society,
Knowle West
Offers support and advice to men, women and children. Send a SAE (A4 size)
Herts SG1 5UX. Tel: 01438 387182
Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.
Please refer to the "archive" on this page, to read more about chemotherapy and hair loss.
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